Agenda and minutes

The Chair welcomed everyone to the meeting.

The Democratic Services Officer drew attention to the evacuation procedure as listed on the call to the meeting.

Councillor Katie Hall sent her apology for this meeting.

Dr Simon Douglass sent his apology for the meeting.  Tracey Cox was a substitute for Dr Douglass.

John-Paul Sanders sent his apology for the meeting.  John Holden was a substitute for Mr Sanders.

At this point in the meeting declarations of interest are received from Members in any of the agenda items under consideration at the meeting.

(a) The agenda item number in which they have an interest to declare.

(b) The nature of their interest.

(c) Whether their interest is a disclosable pecuniary interest or an other interest,  (as defined in Part 2, A and B of the Code of Conduct and Rules for Registration of Interests)

Any Member who needs to clarify any matters relating to the declaration of interests is recommended to seek advice from the Council’s Monitoring Officer or a member of his staff before the meeting to expedite dealing with the item during the meeting.

There were none.

To confirm the minutes of the above meeting as a correct record.

The B&NES Public Services board is working towards a coordinated approach to local services and is now in the process of working towards three key strategies to support this:

·  Health & Wellbeing

·  Environmental

·  Economic

The 2010 B&NES Economic Strategy committed the Council to refresh and renew its plans after a period of three years.  The Council has now commenced work on refreshing the strategy and wishes to take this opportunity to broaden the scope of the strategy to embrace a wider range of Health & Wellbeing Interventions and Outcomes.

The Board is asked to agree that:

·  The review of the B&NES Economic Strategy and the integration of the Health & Wellbeing agenda should be supported.

·  To support the setting up of a sub group to work on the review of the strategy.

The Chairman invited John Wilkinson (Acting Divisional Director for Regeneration Skills and Employment) to introduce the report.

John Wilkinson introduced the report by saying that The B&NES Public Services board is working towards a coordinated approach to local services and is now in the process of working towards three key strategies to support this:

• Health & Wellbeing

• Environmental

• Economic

The 2010 B&NES Economic Strategy committed the Council to refresh and renew its plans after a period of three years.  The Council has now commenced work on refreshing the strategy and wishes to take this opportunity to broaden the scope of the strategy to embrace a wider range of Health & Wellbeing Interventions and Outcomes.

John Wilkinson invited the Board to agree that the review of the B&NES Economic Strategy and the integration of the Health & Wellbeing agenda should be supported; and to support the set up of a sub group to work on the strategy's review.

The Chairman welcomed that the Board has the opportunity to look at, and begin to explore some issues around the economy which may not be looked at within previous similar forms.

John Holden (CCG) asked about confidence of the possible range of the resources over the period mentioned in the report and also if there is an intention to consider some scenario planning in order to test strategic directions coming out of the strategy refresh.

John Wilkinson responded that the Council is doing a lot of work on workplace learning, apprenticeships, etc.  It is about looking at the existing teams and resources and how to deliver the right outcomes with the existing resources.  It is also about shifting the approach and the way how the things are delivered without the need for new, or more resources.  John Wilkinson also said that scenario planning should be part of the refresh.  The Council will be putting in place a range of focus groups to give their views on the economy.

Dr Ian Orpen welcomed that the Board is contributing to the Strategy.  There is a close link between health services and economic settings in the area and it is really useful to have joined-up conversation.

Councillor Dine Romero commented that inequalities do seem to tie in with the whole economic deprivation, which is also linked with health inequalities.  Councillor Romero asked about the work with the connecting families project and how that could be included in the strategy.

John Wilkinson responded that there is a team who work very closely with the connecting families project.  John Wilkinson welcomed the suggestion from Councillor Romero to include the work with connecting families project into the strategy.

Jo Farrar (Chief Executive B&NES Council) explained that the B&NES Public Services Board combines a group of leaders from various public services and voluntary sector organisations that have got together to oversee the agenda across the Bath and North East Somerset and chaired by the Leader of the Council.  It involves police, fire authority, voluntary sector, housing and business.  ...  view the full minutes text for item 24.

The Board is asked to:

·  Note the key recommendations from the health and wellbeing network discussion:

o  Responsibility for skills and workforce development - enabling people to make the most of their life chances is not the role of one particular agency but requires a commitment across schools, employers, providers and public services. This includes actions such as endorsing the value of volunteering as a valuable and beneficial life skill, promoting positive role models, and signposting to the diverse range of local providers who offer support and training. Other simple steps such as constructive feedback from employers on why applicants are unsuccessful can help to reduce barriers to work.

o  Resilience – delivering and promoting activities that help raise confidence and self-esteem, tackle isolation and improve people’s broad social skills can make a valuable contribution to a person’s development.

o  Access - improving accessibility in relation to information and IT would significantly reduce barriers that many people experience in being able to work and make the most of their life chances.

o  Specialist support - The workshops all highlighted gaps around specialist support including support for children aged 5-11 and for disabled people.

The Chairman invited Ronnie Wright (the Care Forum) to introduce the report.

The Healthwatch B&NES Health and Wellbeing Network meeting on 18 September 2013 was an opportunity for health and social care providers and other interested parties to discuss, in more detail, the benefits of work and wellbeing. Conversation included looking at potential gaps in support as well as how joined up working and an understanding of the different elements of support available can help to promote skills and employment opportunities locally.

Website link for the Health and Wellbeing Network Feedback from 18th Sep 2013 documents is available here - http://www.healthwatchbathnes.co.uk/services/working-and-wellbeing

Ronnie Wright invited the Board to note the key recommendations from the health and wellbeing network discussion:

• Responsibility for skills and workforce development - enabling people to make the most of their life chances is not the role of one particular agency but requires a commitment across schools, employers, providers and public services. This includes actions such as endorsing the value of volunteering as a valuable and beneficial life skill, promoting positive role models, and signposting to the diverse range of local providers who offer support and training. Other simple steps such as constructive feedback from employers on why applicants are unsuccessful can help to reduce barriers to work.
• Resilience – delivering and promoting activities that help raise confidence and self-esteem, tackle isolation and improve people’s broad social skills can make a valuable contribution to a person’s development.
• Access - improving accessibility in relation to information and IT would significantly reduce barriers that many people experience in being able to work and make the most of their life chances.
• Specialist support - The workshops all highlighted gaps around specialist support including support for children aged 5-11 and for disabled people.

The Chairman said that he attended the network event and that he was involved in conversation with some of the care providers who were very keen to collaborate.  Some of the issues that came up from the event were about the information signposting and the IT access.

Pat Foster (Healthwatch) said that another issue that was raised from the event was about the apprenticeship scheme and willingness of all organisations to share the apprenticeship programme.

Jo Farrar commented that some of the findings in this report will be useful for the Economic Strategy and agreed that seems to be a specific recommendation about the signposting that needs to be acknowledged.  The Council is involved in the project search within the apprenticeship scheme and the Council would be happy to share its experience with those who are interested in this issue.

Councillor Dine Romero brought two points to Board’s attention: gap in support for 5-11 years old – this is tackled by the Place Services which could be missed in the signposting of services; and the link between the schools and employers - employers should be linked not only with Council schools but also with academies.

Ronnie Wright agreed with Councillor Romero on the link between the school and  ...  view the full minutes text for item 25.

An information report to supplement the presentation on the NHS Call to Action.

This is an information report to supplement the presentation on the NHS Call to Action.

The Chairman invited Ian Biggs (NHS England Director for Bath, Gloucestershire, Swindon and Wiltshire area) and Dr Ian Orpen to give the presentation called ‘NHS Call To Action’.

The presentation ‘NHS Call To Action’ (attached as Appendix 1 to these minutes) highlighted the following issues:

• 65 years of the NHS
• Future pressures on the health service
• What is ‘Call to Action’?
• The national debate
• Aging populations
• What are we doing locally?
• Enhanced nursing home service
• ‘Bath care home 'world-class' - Health Secretary Jeremy Hunt
• Early success for the CCG
• Long term conditions
• Top 5 long term conditions statistics in B&NES
• Community Cluster Teams
• Dementia and what is done locally
• Emergency Care
• Local Actions
• Call To Action for General Practice
• The Integration Transformation Fund
• Seizing future opportunities
• Our refreshed strategic objectives
• The BIG questions we are asking the public
• Health planning timetable

The Chairman said that the conversation on the NHS Call To Action conversation needs to be in public and understood by the community.  The community needs to understand the future of the health and social care services.  One of the key questions is how to keep this conversation on-going within the community considering that things, such as ageing population, etc. are progressing and changing.  The Chairman highlighted excellent history of the close working relationship between the Council and the NHS.  The Integration Transformation Fund will empower us to get faster to desired goals.

Councillor Dine Romero commented that the NHS Call To Action seems to be targeting adults and older age population and it should also target young people to take part.

Dr Ian Orpen responded that there is absolutely no minimum age in the NHS Call To Action.  As an example – one of the areas targeted by the NHS Call To Action is the obesity amongst the children.

Jo Farrar welcomed the joined-up approach highlighted in the presentation and suggested that this, or similar presentation could be presented to the Public Services Board.  Jo Farrar also highlighted the importance of data sharing between the Council and the NHS.

John Holden praised the work of Dr Ian Orpen and Ian Biggs for coming up with new ways of doing things better and more efficient.  John Holden also said people need to be assured that the NHS still belongs to them.

Ian Biggs responded that the NHS England needs to provide some sort of resource to help local conversation with the public.  It is important to have conversation with the public; this must not be seen as public consultation. 

Councillor John Bull (Board Observer and Paulton Ward Councillor) asked how far we are with the ‘7 day GP surgeries’ in B&NES and how far are we with the best practice when people are making appointments with their GP surgeries.

Dr Ian Orpen responded the CCG is obliged to improve the quality though the GP practices are under control of the NHS England.  The ‘7 day GP surgeries’ – the workforce is not there, which is the reality.  ...  view the full minutes text for item 26.

The Health and Wellbeing Board will receive a verbal presentation from Dr Ian Orpen.

The Chairman invited Dr Ian Orpen to provide verbal update related to the Care Quality Commission (CQC) report on the Royal United Hospital (RUH) in Bath.

Dr Ian Orpen addressed the meeting with the following statement:

‘In June 2013, a CQC unannounced inspection was undertaken to check whether the Royal United Hospital Bath NHS Trust (RUH) had taken action to meet essential standards following a previous responsive inspection in February 2013.

During the inspection, CQC looked at three areas of care at the hospital. These were the older people’s wards, the emergency department, the DSU and the theatre recovery area. The report highlights several areas of good practice and states that the majority of staff met with showed a professional and caring attitude towards their patients, it also acknowledges that previous concerns on the DSU had been addressed. However, concerns were identified on the older people’s wards and with some of the corporate governance processes. CQC felt that action was needed against four of the standards checked and enforcement action was taken against one.

• Respecting and involving people who use services - Action needed
• Care and welfare of people who use services- Action needed
• Cooperating with other providers - Met this standard
• Safeguarding people who use services from abuse - Action needed
• Assessing and monitoring the quality of service provision - Action needed
• Records - Enforcement action taken

The Trust was asked to provide an action plan by the 19th October setting out what they will do to meet the standards. The CQC will check to make sure that action is taken and will be revisiting the trust in December as part of the new style hospital inspections programme announced which the trust has welcomed.

The CCG is in regular contact with the trust to offer support where appropriate and to seek assurance that the action being taken will improve the quality of service provided.

As previously reported to CCG Board, the CCG Clinical Lead, Director of Nursing and Lay Members have and will continue to undertake site visits and ward walkabouts on a monthly basis. The older people’s wards have not yet been visited as the CCG knew that CQC had undertaken the inspection in June.

The trust has provided the CCG with a copy of the action plan. The CCG also meets monthly with the trust at the Clinical Quality and Outcomes meeting where the action plan will be actively monitored.

The CQC, Local Authority and CQC meet on a monthly basis to share good practices but also to highlight concerns within providers of health and social care services. Updates from the CQC will be received at these meetings.

The Local Adult Safeguarding Board will receive a progress report in December and the Chair of the Board is in contact with the CCG.

The CCG is working not only with the trust, CQC, Wiltshire and Somerset CCGs but with the Trust Development Authority (TDA) and NHS England - South and BaNES, Gloucester, Somerset and Wiltshire Area Team to  ...  view the full minutes text for item 27.

The Health and Wellbeing Board will consider PowerPoint presentation from Dominic Morgan.

The Chairman invited Dominic Morgan (B&NES CCG Urgent Care Network Programme Lead) to give the presentation called ‘Winter Planning 2013/2014’.

The presentation ‘Winter Planning 2013/2014’ (attached as Appendix 2 to these minutes) highlighted the following issues:

• Winter Planning 2013/2014
• Newspaper clips related to A&E issues
• Strategic Aim
• Continuous Planning Cycle
• Operational Performance Management Framework (OPMF) - Structured Approach
• Urgent Care Dashboard
• Escalation – Terminology
• Daily Status Reporting – Providers
• Daily Status Reporting – System Wide
• Operational Practice – daily
• Winter Pressure  Schemes

John Holden asked if it all works as suggested in the presentation, will the same process continue year in year out, and to deal with the pressure whatever time of the year is in question.  John Holden also asked what would be the cost of the resources re-directed from usual jobs to participate in this work.

Dominic Morgan responded that there is a level of risk though the Board should receive an update in March 2014 to review the process.  The process will follow the clear guidance from the NHS England.  There is a lot of effort put into winter planning and resourcing operational management on daily basis already.  This is not about putting the additional resources – it is more aligning the existent resources. 

It was RESOLVED to receive an update for March 2014 meeting.  

The Department of Health (DH) is consulting on how to implement major reforms to adult social care.  The consultation covers:

·  How to manage the large increase in demand from people who pay for their own care and support; and

·  Major changes to social care practices and systems, including assessment and charging

The proposed reforms have significant implications for the Council and also, for some key partners.  The direct impact will be on care assessment and financial systems but there will be knock-on effects including on market management, information and integration.  This report includes commentary from the Local Government Information Unit (LGiU).  Bath and North East Somerset’s position and any associated specific issues are summarised in the report.

The Board is asked to:

·  Note the key proposals in the Care & Support Bill and early analysis of the implications for Bath and North East Somerset Council and other key partners;

·  Note the establishment of a Task Group to: undertake an initial assessment of financial and policy implications; staff resourcing requirements (implementation and on-going); risk assessment and establish a project plan, including key decisions;

·  Receive a further update in early 2014.

The Chairman invited Jane Shayler (Deputy Director for Adult Care, Health and Housing Strategy and Commissioning) to introduce the report.

The Department of Health (DH) is consulting on how to implement major reforms to adult social care.  The consultation covers:

• How to manage the large increase in demand from people who pay for their own care and support; and
• Major changes to social care practices and systems, including assessment and charging

The proposed reforms have significant implications for the Council and also, for some key partners.  The direct impact will be on care assessment and financial systems but there will be knock-on effects including market management, information and integration.  This report includes commentary from the Local Government Information Unit (LGiU).  Bath and North East Somerset’s position and any associated specific issues are summarised in section 4 of the report.

Jane Shayler invited the Board to:

• Note the key proposals in the Care & Support Bill and early analysis of the implications for Bath and North East Somerset Council and other key partners;
• Note the establishment of a Task Group to: undertake an initial assessment of financial and policy implications; staff resourcing requirements (implementation and on-going); risk assessment and establish a project plan, including key decisions;
• Receive a further update in early 2014.

The Chairman welcomed the report and welcomed the Care and Support Bill.  The Board must be really mindful of the forthcoming initiatives, issues such as Integration Transformation Fund.  The Bill is making things clearer for people.  It is also helpful on carers’ needs and support for self-funders to access the range of information.

Councillor Dine Romero expressed her concern that if there is large number of people that are able to fund themselves then it could lead to inequality across the area.  The bigger question would be if there is a danger that this could lead to the ‘post-code lottery’ types of availability of care.

Jane Shayler responded that there is a possible ‘post-code lottery’ currently in the area.  This is partly because, even though there are national regulations associated with charging of residential care, there is guidance on charging of social care in the community setting which is subject to local interpretation and local policy.  There is also some inconsistency in terms of the charging arrangements.  The Care and Support Bill will introduce the national eligibility threshold for adult social care so it will no longer be subject to local determination.

Jane Shayler added that there is a very rigorous assessment of individual's ability to pay for services.  Whether individuals are able to pay or not for service, they are given information and support and there is a level of ongoing overview of the local authority and those acting on behalf of the local authority to make sure that care needs are being made.  If the individual does not pay, though it is known that they can pay for services, then the risk assessment is undertaken. 

Ashley Ayre commented that the Care and Support Bill is  ...  view the full minutes text for item 29.